These are patients who have infections that are not sensitive to any of the antibiotics and have to be treated with a cocktail of antibiotics belonging to different categories, said a doctor.

At AIIMS, 60-70% of all the infections in the ICU are multi-drug resistant.(Shutterstock)

Around 7-8% of patients admitted in the intensive care units (ICU) are infected with pan-drug resistant bacteria that is difficult to destroy with existing antibiotics, said doctors from All India Institute of Medical Sciences on Tuesday. Such infections are harder, longer and more expensive to treat the patient.

“The degree of antibiotic resistance is determined in the laboratory but in practical practice, these are patients who have infections that are not sensitive to any of the antibiotics and have to be treated with a cocktail of antibiotics belonging to different categories,” said Dr Arti Kapil, professor at the department of microbiology at the hospital.

There are three categories of antibiotic resistance; pan resistance being the most difficult to treat, followed by extensively drug resistant infections that do not respond to at least one drug in all but two antimicrobial category. The last is multidrug resistant infection that does not respond to at least one drug in three antimicrobial drug categories. At AIIMS, 60-70% of all the infections in the ICU are multi-drug resistant.

To reduce the use of antibiotics further, doctors at AIIMS are researching various point-of-care tests.
(Shutterstock)

“This scenario is true of almost all tertiary-care hospitals in the country. This is because people usually reach these centres after having antibiotics prescribed by several other centres before,” said Dr Randeep Guleria, director of AIIMS, Delhi.

November 13 to 19 is celebrated as World antibiotic awareness week. The hospital has to work hard to protect the efficiency of the existing antibiotics as the last new class of antibiotics was discovered in 1987 and the world is now running out of options. An antibiotic stewardship programme ensures that certain restricted drugs are used only when necessary and with the concurrence of senior physicians. The hospital also has antibiotic policies for all its ICUs depending on the resistance pattern determined by the microbiology department.

To reduce the use of antibiotics further, doctors at AIIMS are researching various point-of-care tests. “Some infections like pneumonia can be caused by bacteria or viruses. Having a point-of-care test can tell the doctor immediately whether the person needs antibiotics, which are useless against viral infections,” said Dr Guleria.

Following simple hygiene practices such as handwashing helped AIIMS lower the infection rate in its ICUs over seven years. Ventilator-acquired pneumonia went down from 22.5 per 1,000 days on ventilator to 6 and blood stream infection went down from 8 per 1,000 catheter days to 0.52 catheter days.